Medicare vs. Medicaid: Know the Difference

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Medicare and Medicaid both provide health care coverage, but they're very different. Get to know both, so you can understand what's covered and if you're eligible for them.


Let's start with Medicare

This federal health insurance program has you covered (for the most part) if you are 65 and older or have certain disabilities or conditions, no matter your income. Medicare has four parts — A, B, C, and D. Part A covers hospital insurance. Part B covers medical insurance, like doctor's visits. Parts A and B combined make up "Original Medicare."

Part C is called Medicare Advantage. You can enroll in a Medicare Advantage plan from private insurance companies, like Aetna. Medicare Advantage combines Parts A and B and may even offer prescription drug coverage (also known as Part D). And Medicare Advantage may include additional benefits like eye care, hearing, wellness services, or a nurse phone line.

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Now, meet Medicaid

Medicaid is a joint federal and state public health insurance program for people with low income. Its covers a broad array of health services and limits out-of-pocket costs. The program is also the principal source of long-term care coverage for low income Americans.

To participate in Medicaid, federal law requires states to cover certain groups of individuals. Some examples include low-income families, qualified pregnant women, children, and individuals receiving Supplemental Security Income (SSI).

What does Medicaid cover? All states are required to provide inpatient and outpatient hospital services, physician services, laboratory and x-ray services, home health services, and more.

It's up to each state on whether they want to provide "optional" benefits. These can include things like prescription drugs, case management, physical therapy, and occupational therapy.

Every state has its own rules surrounding Medicaid eligibility and how to apply for Medicaid benefits. That's why it's important to check with your State Medical Assistance (Medicaid) office to see if you qualify.

You may qualify for both Medicare and Medicaid

Millions of Americans are eligible for both programs — 8.3 million, according to the Centers for Medicare & Medicaid Services. If you're eligible for both Medicare and Medicaid, you're considered to be "dual eligible."

If you're dual eligible, you may qualify for Extra Help with your Medicare Part D prescription drug costs.

Remember, if you're struggling to make ends meet, do your research on Medicare and Medicaid. There's a chance you'll quality for both — so you can get coverage that works for your health and your wallet.

Amy Capomaccio is a health care writer at Aetna with experience in senior wellness, Medicare, Medicaid, and commercial health care. When she's not practicing new mindfulness techniques, Amy is spending time outdoors and traveling. Amy hails from Wakefield, MA and has a degree in Advertising and Public Relations from the University of Tampa.

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